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Recurring fever even after antibiotics course, lump size node in lower back. Low Hb, RBC. Treatment ?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
My son can not get well. Been sick since. January this year. Fever 100-103. Ten days of antibiotics, three days after finish antibiotics...fever back. We have done this four times. Was transferred to LSUS (which is awesome) spent couple days there. They can not figure it out either. SED rate 26. CRP 10. White blood count 20-0000 but can get it down to around 0000 temporarily. Rbc, hemaglobin and hematacrit slightly low. Lump the size of a large marble XXXXXXX lower right back he just showed me yesterday. Says he just doesn't feel good. Not normal activity level. Pale. Low grade fever everyday 99-100. Only major history is nystagmus, low vision, XXXXXXX chiari reduction surgery two years ago.
Posted Tue, 22 May 2012 in Child Health
Answered by Dr. Hema Yadav 5 hours later
Thanks for posting your query.
Prolonged fever for more than 3 weeks without a specefic usual cause is termed as pyrexia of unknown origin (PUO).
PUOs are caused by infections (30-40%), neoplasms (20-30%), collagen vascular diseases (10-20%), and numerous miscellaneous diseases (15-20%).The list of possible causes is very long, the more probable ones in his case being ,
Fungal infections/Parasitic infections
Lymphomas/Leukemias/Solid tumours
Collagen vascular and autoimmune disorders
Endocrine disorders

The exact cause can only be established after extensive diagnostic evaluation by his doctors, which in his case is most probably an infection .
Considering his present blood tests it his advisable that he undergo the following investigations as per his doctors advise
1.A blood and urine culture test.
2.A CT scan of abdomen and brain (to rule out post surgery long term complications like infection or abscess)
3.A fine needle aspiration cytology of the lump he has (most probably a lymph node)
4.A mantoux test for ruling out lymph node tuberculosis.
I hope his doctors would come to the exact conclusion soon.
Please do not worry as many of these causes are very much curable conditions.
Hope I have answered your query.
Above answer was peer-reviewed by
Follow-up: Recurring fever even after antibiotics course, lump size node in lower back. Low Hb, RBC. Treatment ? 3 hours later
He has had ct of abdomen and pelvis. Both clear. Rheumatologist work up was also negative. Cat scratch fever-negative. Mono-negative. Strep-negative. Forgot to tell you he has night sweats and is very itchy. He complains ALOT of nausea, but never throws up. Sister has lupus and rheumatoid arthritis, onset age 15. Is the CRP that high? They acted concerned about that. Also could the lump be caused by rocephen shot from one week earlier? The lump is indented. Does that mean anything? Cant feel it unless you push really hard. Also complains of back pain on spine between shoulder blades if I push lightly on it. Do you think they are overlooking his previous brain surgery too much? I keep asking and they keep saying its not related. Should I ask for brain ct/MRI. Thank you for your time. I really wanted a second opinion. We see an infectious disease Dr at LSUS in Shreveport, Louisiana this Wednesday. Any other suggestions would be greatly appreciated! Thank you so much once again for caring. Thank you and may God bless you!
With kindest regards, Becky
Answered by Dr. Hema Yadav 8 hours later
Hello ,
Thanks for the follow up.
Answer 1.Yes the Crp is mildly raised which may be sugesstive of viral infections or any inflammatory condition be it immune related or infective.The normal value is usually less than 10 for most healthy individuals.
Answer 2.There is a possibility of the lump being a hematoma due to the rocephen shot which is known to cause local thrombophlebitis however it should show some decrease in another weeks time.The indentation could be due to it's fixity to skin and underlying tissue.But it does not rule out the possibility of an abscess or lymph node.
Answer 3 There is a possibility that the present complaints are unrelated to the brain surgery, nevertheless an MRI brain and spine is indicated if all other work up is negative to rule out neurological cause of the PUO.
Answer 4.Since the most probable reason for his complaints, fever, night sweats , lump, pain etc can be a viral or chronic bacterial infection it is good to get an opinion by the infectious disease specialist.In that case further investigations can be postponed till his consultation and advice.
Hope that answers all your queries.
Above answer was peer-reviewed by
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